Integrating the Healthcare Enterprise

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Integrating the Healthcare Enterprise

• Scheduled WorkflowThe First Profile

Kevin ODonnell Toshiba Medical Systems Co-chair,
IHE Radiology Planning Cmte
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Scheduled WorkflowAbstract / Scope

• Genesis 1 In the beginning,
• or better yet
• Genesis 11 Tower of Babel
• and there confound their language, that they may
  not understand one another's speech.

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Scheduled WorkflowAbstract / Scope

• Backbone of IHE Radiology
• Integrates Registration, Scheduling, Acquisition
  Workflow and Image Content
• Bridges HL7 and DICOM Spaces

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Scheduled WorkflowValue Proposition

• Preserve Order Continuity
• Close the Loop
• maintain accession number, avoid confusion with
  Filler , Placer , etc.
• Improve Demographic Integrity
• Data entry errors
• significant occurrence
• significant consequences
• Enter once, pass from system to system

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Scheduled WorkflowValue Proposition

• Improve Workflow Efficiency
• Use of Worklists
• less time spent doing data entry/selection
• enables semi-automation of setup
• Reliable Storage
• Storage Commitment
• fewer lost studies
• more confidence in results

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Scheduled WorkflowValue Proposition

• Improve Order Tracking
• MPPS from Modality to RIS PACS
• more timely feedback
• more precise feedback
• Reduce Integration Effort at Site
• Get Vendors on the Same Page
• Provide Implementation Guidance
• Pre-test at Connectathon

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Scheduled Workflow Profile
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IHE Workflow Concepts
IHE has selected three UNAMBIGUOUS HL7/DICOM
TERMS
ORDER A request for radiologic
service
REQUESTED PROCEDURE A Unit of work
resulting in one Report (with associated
codified, billable acts)

• PROCEDURE STEP The smallest unit of
  work in the workflowScheduled Procedure Step
  A unit of work to do Performed
  Procedure Step A unit of work done

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Workflow Concept Mapping

• This 3 level workflow structure is user oriented

ORDERA request for imaging service (Accession
Number)
REQUESTED PROCEDURE Units of work resulting in
one Reportwith associated codified, billable
acts(Requested Procedure ID)
PROCEDURE STEP The smallest unit of workin the
workflow (modality worklist entry)
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Normal Workflow
Typical workflow One Order One Procedure One
Report
Radiology Department
ORDER A request for RadiologicService
Set of Codifiable, Billable, Acts
Report
Requested Procedure
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Multiple Modality Steps
Radiology Department
ORDER A request for RadiologicService
Set of Codifiable, Billable, Acts
Requested Procedure 1
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Scheduled WorkflowHL7 Actors Transactions

• HL7 Actors
• ADT/Patient Registration
• Order Placer
• DSS / Order Filler
• Image Manager

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Scheduled WorkflowStandards Used

• HL7 V2.3.1
• Patient Registration
• Admit A01 (In Patient), A04 (Out Patient), A05
  (Pre-Admission)
• Cancel A11 (Cancel Admit), A38 (Cancel
  Preadmit)
• Patient Update
• Transfer A02 (Patient Transfer)
• Update Patient Class A03 (Discharge),
  A06(Outpatient becomes Inpatient), A07 (Inpatient
  becomes Outpatient)
• Update Patient Information A08 (Update)
• Merge Patients A40 (Merge)
• Cancel A12 (Cancel Transfer), A13 (Cancel
  Discharge)

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Scheduled WorkflowStandards Used

• HL7 V2.3.1
• Order Management
• New Order ORM/NW ORM/SN (New Order)
• Order Status ORM/SC (Status Change)
• Cancel ORM/CA, ORM/DC ORM/OC (Cancel Order)
• Procedure Details
• Scheduled ORM (Procedure Scheduled)
• Updated ORM (Procedure Updated)

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Scheduled WorkflowDICOM Actors Transactions

• DICOM Actors
• DSS / Order Filler
• PPS Manager
• Image Manager /Archive
• Acquisition Modality
• Evidence Creator
• Image Display

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Acquisition Workflow Management

• DICOM
• Modality Worklist Management (MWL)
• Modality Performed Procedure Step (MPPS)

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Image Management

• DICOM
• Image Storage
• Storage Commitment
• Query/Retrieve

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Additional Workflow Management

• HL7
• ORM Message
• DICOM
• Query (C-FIND)
• Modality Performed Procedure Step (MPPS)

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Patient Information Reconciliation

• Expect the Unexpected

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Patient Information ReconciliationAbstract /
Scope

• Extension of Scheduled Workflow
• Coordinated update of demographic information in
  workflow and content objects

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Patient Information ReconciliationValue
Proposition

• Handle exception cases
• Trauma/Emergent Cases
• Patient Unknown or no time for Registration
• Entry Errors by Operator
• Other Demographic Changes
• (e.g. married name)
• Multiple sources/destinations for updates
• High risk of unsynchonized/inconsistent data
• Workflow must continue
• Need to pull together past current patient
  records

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Use Cases

• Local policy calls for ADT to pre-register ER
  patients (John Doe, Jane Doe)
• Case 1 Unidentified Patient registered at ADT
  and order is placed at Order Placer.
• Case 2 Unidentified Patient registered at ADT
  and order is placed at DSS/Order Filler.
• Case 3 Unidentified Patient registered at ADT
  but acquisition completed at Modality prior to
  order.

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Use Cases

• Local policy allows departments to register ER
  patients with Departmental IDs
• Case 4 Unidentified Patient assigned temporary
  Departmental ID and scheduled at DSS/Order
  Filler.
• Case 5 Image Acquisition completed prior to
  assigning temporary Departmental ID or Order
  (Patient ID entered at the Modality).

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Patient Information ReconciliationTransaction
Diagram
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Emergency - Case 3
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More information.

• IHE Web site www.ihe.net
• Technical Frameworks Supplements
• Non-Technical Brochures
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Product Integration Statements